Posted by SLS on August 4, 2002, at 13:25:26
Nardil + imipramine = serotonin syndrome
I had been adding Nardil to a combination of Lamictal 300mg and imipramine 300mg. I never had any problem with a similar combination using high dosages of Parnate. My muscles became rigid, especially around the neck. I had difficulty walking and was very weak and unsteady on my feet. My leg muscles were rigid. I experienced tremors throughout my whole body and sweated profusely. I became dysphoric and found it difficult to focus on what was going on around me. I thought these things were due to the NE reuptake inhibition and anticholinergic effects of imipramine. After some consideration, my doctor decided that it was the onset of serotonin syndrome. I was OK until the dosage of Nardil was raised from 45mg to 60mg. I had been titrating very slowly, having reached 60mg after at least 8 weeks.
I guess I have been underestimating the potency of tertiary tricyclic TCAs to inhibit the reuptake of serotonin. The only problems I ever had using Nardil with desipramine, an extremely selective NE reuptake inhibitor, was low blood pressure and urinary hesitancy.
I guess the lesson is that a healthy respect for the serotonergic properties of TCAs is warranted when combining them with MAOIs, particularly Nardil.
- Scott
poster:SLS
thread:115170
URL: http://www.dr-bob.org/babble/20020731/msgs/115170.html